MEDICARE: COLEMAN VISION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1225745516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLEMAN VISION

Provider Business Mailing Address
First Line	:	5051 JOURNAL CENTER BLVD NE STE 400
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-5907
Country	:	US
Telephone Number	:	505-821-8880
Fax Number	:	505-821-8887

Provider Business Practice Location Address
First Line	:	5051 JOURNAL CENTER BLVD NE STE 400
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-5907
Country	:	US
Telephone Number	:	505-821-8880
Fax Number	:	505-821-8887

Authorized Official
Title or Position	:	OWNER/SURGEON
Name	:	DR. STEPHER COLEMAN
Credential	:	MD
Telephone Number	:	505-821-8880

Provider Enumeration Date	:	11/04/2022
Last Update Date	:	11/04/2022

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Directions to “COLEMAN VISION ” Practice Location

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